HIV and AIDS Clients in Psychology - Literature review Example

It is believed the psychology emerged on its modern footings almost a century ago however its influence is still considered to be current in terms ofits impact on the overall sciences related with mental and physical health of a person. What was most fascinating about this emergence of the psychology is the fact that it had radically changed the way we use to perceive and view life at large. However no science can play a constructive and positive role in society until and unless it is not ethically practiced. Ethics in any field of science and arts play critical role in defining the overall formation of the profession as following highest ethical standards are considered as the cornerstone of the individual’s achievements in her chosen field. However ethical standards also vary according to the profession of a person and it is also evident that presence of many professional bodies in one profession may outline their own ethical standards and guidelines to follow thus ethical standards have very rich and diverse nature as compared to other professional guidelines. In many cases, following ethical standards is a legal binding whereas in other cases, following ethical standards is considered as the moral binding of the person who is practicing the profession. Ethics in psychology are one of the most important areas of the overall profession which greatly shape the professional conduct of the profession. Psychology in its essence a science which is not only delicate but also difficult to practice gives the overall impact it can have over the mental and physical health of the person. The issue of ethics further complicates when it comes to dealing with patients diagnosed with HIV and AIDS as it not only involve the role of psychologist in the overall management of the patient’s mental health but also place a psychologist in a different position in terms of the patients’ families and their friends. Psychology and Ethics Traditionally psychologists have relied on the principles of value avoiding and value neutral model where it was believed that in order to get the truth- the truth about the person, moral values could not be taken into account. (Lowen, 1993). However, psychology developed the habit of evaluating a person’s mental health in terms of the cultural set up and norm under which a person use to live therefore the ethical values also emerged in that context as there emerged a greater divide between the profession and its ethics. The criteria for the evaluation of human existence and the ability of psychologists to view the same in that particular set of environment rendered the professional dexterity to the minimum as the ethical scope of the profession broadened. With the advent of new type of diseases such as cancer, HIV and AIDS, the role of psychologists greatly increased too putting them under great scrutiny due to the multidimensional impacts of those diseases not only on the physical and mental health of the patients but of their families and friends too. However one must also understand the way changes in medical technology is taking place thus effectively making a great shift towards the practice of the profession on more ethical grounds as compared to its practices which were in practice before the development of medical technology thus there is a very blurred line now between what is ethical and what is not. The question remains as to how those who practice the profession view it from the perspective of its perceived ethical boundaries. Literature Review “Ethics is the systematic study of moral reasoning in theory and practice. It clarifies questions about right and wrong, but also demonstrates their complexity: most ethical theories and many moral judgments are contestable. Some norms, values or principles are sufficiently widely agreed for codes of professional practice or laws to be based on them. But no ethical theory or decision-making method yields unequivocal conclusions which convince everybody: too many different beliefs, philosophies, cultural backgrounds and life experiences influence our views of right and wrong. Meaningful and constructive discussion of practical ethical problems nevertheless is possible when conceptual frameworks developed throughout the history of ethical reasoning are used to examine the facts and values in question. Such discussions can lead to a degree of consensus, or at least to a mutual understanding of divergent views.” (Benn & Boyd, 1996). Divergent views in the sense that ethical boundaries, with the improvements in the medical technology have blurred the way traditionally ethics were seen and practiced. Further the divergent views are also important within the context of HIV and AIDS patients because of the fact that one quarter of the HIV and AIDS patients fall within the age bracket of 15 to 24 years and more than half of the new infections are happening in age group below 25 therefore there arise a great ethical issue of including the young patients into the clinical trials developed for finding the effective cure of the diseases. This view therefore present multiple and divergent school of thoughts in ethics. However, most of the psychological and medical associations have also laid down some standard criteria to be followed by the organizations. Ben & Boyd are of the view that besides following broader theories of ethics, professionals also take into consideration various ethical principles when dealing with the issue of clinical trials on HIV and AIDS patients having age group of less than 25 years. On the much broader scale, there are three core principles which have been extensively discussed and practiced. These three core areas include respect for the person, beneficence and justice. Ben and Boyd are of the view that the respect for individual includes providing access to the information which helps individuals to decide upon themselves however when a psychologist is managing a patient with HIV and AIDS, psychologists may not fully comply with this ethical standard as patients who pass through intense trauma can develop tendencies to commit suicides. Since an HIV and AIDS patient also goes through social isolation therefore psychologists have to make a trade off when disseminating information to their clients regarding their mental health emerging as a result of the physical symptoms of HIV and AIDS. Informed consent is another very important ethical dilemma which most of the practioners including psychologists face. Since there are special procedures for conducting the tests for HIV patients because of the fact that HIV testing has some psychosocial implications such as rejection by the family, social isolation, discrimination in jobs, restricted or no access to the proper health facilities and lack of proper health insurance and housing creates immense consequences for the patients therefore the role of psychologists in helping the individual to go through all this in order to prepare one for the HIV testing becomes much more complicated and difficult in terms of ethical practices. There is also a great debate over how the patients will react to the results of the HIV testing as there is a strong psychological effect of the same on the client. A very commonly held view is that of the fact that informing about the HIV tests have detrimental psychological impacts on the clients that may lead to the great distress, depression and possible increase of suicidal tendencies into the HIV patients therefore psychologists need to view the issue of HIV testing and the informed consent in much bigger perspective rather than viewing it in more closer and with narrow scope limiting it just to the patient’s mental health. (Sieff, Dawes, & Loewenstein, 1999). As discussed above that sometimes following ethical guidelines become the legal duty of the person therefore it becomes evident to the psychologists that ethical following of the practice is not just the moral duty but a legal too however “Some states permit HIV testing without informed consent under specified circumstances. For example, many states permit testing of patients without permission after a significant exposure to emergency response workers or health care workers occurs, although permission generally must be sought. In addition, some states permit the testing of prisoners and persons accused of sex crimes. Connecticut and New York also require mandatory HIV testing of newborns,(22,23) which indirectly reveals maternal HIV status.” (Wolf & Lo, 2001) thus the issue of informed consent sometimes do not become more delicate as when legal binding are removed than it is all up to the psychologist to deal with the trauma of the patient in terms of her reaction to the HIV testing as many studies have suggested the strong link between the patients’ expectations and the anticipated behavior with the HIV testing results. The ethics in psychology become much more complicated when it comes to dealing with the patients who are women. This is complicated because of the fact that the expectations of the women regarding the results of the HIV testing can be potentially different from that of men. “Women may lack the decision-making freedom to participate in a trial, especially a trial that addresses sexual behavior. They may be burdened with childcare and a lack of transportation. For women with children, participation is often limited by having to attend one of the few trial sites that offer childcare. Indeed, trials requiring that pregnancy and breast-feeding be avoided may place undue stress upon participants in cultures that place value on womens fertility. Some cultural barriers identified in the recent HIV vaccine candidate trial in Kenya included womens belief that a woman of childbearing age who uses contraceptives is giving her husband an excuse to look for another woman with whom to bear children. On the other hand, men believed that childbearing was a way of keeping women from infidelity. Condoms, which were recommended for use during the trial, were perceived as instruments to promote extramarital relationships.” Thus most of the ethical issues in psychology related with the HIV and AIDS patients tend to have been concentrated mostly on two counts of pre testing and post testing of HIV and finally its management. There has also been a debate as to whether when it comes to discussing the role of psychologist after the positive diagnosis of the HIV is whether the psychologist is ethical binding to generate the required social support for the patient. As discussed above that the consequences of HIV diagnose are not only psychologically difficult for the patient itself but his or her family members as well as peers too and HIV diagnosed usually face the social isolation. Since the access to social support is largely dependent upon the disclosure of the HIV status of the patient to his or her family members and peer groups and people who could successfully inform their family members, friends and colleagues about their HIV status tend to have great tendency to cope with the psychological stress therefore the role of psychologist becomes much more complicated and difficult to assess and function in terms of the ethical functioning of the profession. (Kalichman, 2007) In such kind of situations, the overall burden on the psychologist increase and a dilemma emerges as to whether the psychologist should play its role beyond the simple role of just psychologist and the patient or a person who can help the HIV victim to not only cope with the psychological stress related with the physical symptoms of the disease but also help the patient in gaining the necessary social support form his or her family and peer groups including friends and colleagues. Lastly, there is also a debate regarding the research ethics in psychology in terms of HIV and AIDS. As discussed above about the informed consent and the role psychologist can play, there is also a dual role for psychologist when it comes to researching the psychological impacts of HIV on the patients. Here informed consent becomes more complicated because while researching for the subject as “The expectations of potential research participants may complicate obtaining informed consent in the research context. Although the goal of research is to test a hypothesis and develop generalizable knowledge, many participants enter research studies to benefit personally. The language that investigators use (e.g., "experiment" vs. "research") may have significantly different meanings for participants and affect their understanding of their participation. Many participants also do not understand randomization and expect that decisions about which intervention they receive will be based on their individual clinical needs. Some may not even be aware that they are participating in research. Some of these misconceptions may arise because patients apply their own experience with health care providers, who have an ethical obligation to place patients interests first, to the research setting, which must take responsibility for the scientific and logistical aspects of the research as well as the interests of the individual participant. Because of such hopes and misconceptions, patients may misinterpret the information given to them about the study.” (Wolf & Lo, 2001) Thus the ability of the psychologist to exert influence over the patient give researcher the more influence and power to shape the consent and final opinion of the patient therefore it become more complicated and ethically more penetrating to exercise care and practice utmost ethical standards to conduct the research in its true sense. Conclusion Psychology and ethics are considered as two complimentary subjects as without exercising ethics in their proper and true sense, it may become difficult for the profession to evolve and function on more scientific footings. There are many issues which discuss the role of ethics in psychology while dealing with HIV and AIDS clients including the informed consent, mutual benefit of both the patient and the psychologist. However, the issues become more complicated when it comes to dealing with research in psychology on HIV patients. Bibliography Benn, C., & Boyd, K. (1996). Ethics, medical ethics and HIV/AIDS - Does Ethics Divide or Unite? Some Orthodox Visions of Ecumenism. Ecumenical Review , 5. Kalichman, S. C. (2007). HIV/AIDS Case Managers and Client HIV Status Disclosure: Perceived Client Needs, Practices, and Services. Health and Social Work, , 23, 259+. Lowen, J. (1993). Is Everything Permitted? Reconnecting Psychology and Ethics. Free Inquiry , 13 (3), 22+. Sieff, E. M., Dawes, R. M., & Loewenstein, G. (1999). Anticipated versus Actual Reaction to HIV Test Results. The American Journal of Psychology , 112 (2), 297-311. Wolf, L. E., & Lo, B. (2001, August). Ethical Dimensions of HIV/AIDS. Retrieved June 20, 2008, from HIV InSite Knowledg: http://hivinsite.ucsf.edu/InSite?page=kb-08-01-05 Mills E, Nixon S, Singh S, Dolma S, Nayyar A, et al. (2006) Enrolling Women into HIV Preventive Vaccine Trials: An Ethical Imperative but a Logistical Challenge. PLoS Med 3(3): e94 doi:10.1371/journal.pmed.0030094 Read More